Reflective Journal for Preceptor Experience
My most astounding experience was in the delivery room. It was a C- Section delivery whereby my engagement was with the obstetrician conducting the surgery along with my preceptor. The Issue pertained to addressing TIME OUT while awaiting the spinal tap administration. It was explained to me that according to Joint Commission mandates TIME OUT is a very significant surgical preparation procedure. It encompasses a preoperative verification process whereby the assisting nurse has to apply a standard in verifying the correct patient, surgery and site (Speak up, 2016). Also, I witnessed verification and marking of the incision site by the obstetrician. Administering the anesthesia into the spine as a operative measure could be uncomfortable. My duty was reassuring the patient during drug administration facilitating the process making it less difficult for the anesthetist to placing the drug into the cavity.
Another very effective learning communication with my preceptor entailed assisting the surgical tech in counting instruments. This person is also responsible for applying sterile drapes across the incision site. After the surgery is completed another responsibility is weighing the blood loss and counting the swabs used in to surgery to make sure that any is left in the patient to cause sepsis being a foreign body. The infant was evaluated by the anesthetist and pediatrician who has to be present at birth of the infant during a C- section surgery. The infant APGAR score evaluation is very important in determining successful transition of the infant from intrauterine to extra uterine life.
APGAR SCORE contains five significant features. My preceptor explained that the infant is scored from 0 to 10. 10 is the highest possible score indicating Appearance, Pulse, Grimace, Activity and Respiration. Poor appearance could mean that the infant is cyanosed and does not respond to stimuli normally. The pulse could be normal or abnormal, Grimace indicates the infant’s response to reflect stimulation. A limp infant does not respond. However, a healthy one responds vigorously. Legs could resist extension, which is a serious Apgar score indication regarding reflexes. The last evaluation is the respiratory effort. This ranges from strong to week or absent in cases of a still birth infant (Finster & Wood, 2 015).
This infant’s condition was pink in appearance upon birth. The score ascribed was 2. Pulse was normal, stimulation of reflexes acceptable, but there as a grunting respiratory sound. The respiratory therapist as called out to evaluate the infant. Further tests were ordered. Some respiratory therapists say that this sound is perfectly normal, while others see it as early signs of respiratory distress. Pediatricians or neonatologists see grunting as a way of adjusting to extra uterine life being more a digestion issue rather than respiratory. Indications are that they may have gas in the intestine and the central nervous system does not know how to differentiate the difference. As such, an occasional grunting is a mechanism developed to bring relief from this discomfort. Other theory is linked to the condition being that the infant learning how to have a bowel movement (Cafasso, 2015).
With respect to delegation of duties there was a difficulty in finding persons to assing duties because no aids worked in the operating room. We were all trained or in training operating room attendants. Besides, Obstetrics is a nursing specializations. For a preceptor to invite a student into a C- Section operating room the student must indicate that at some time in his/her career they would enter that specialty. My assignment was filled with new learning experiences. I was exposed to current evidence-based practices within the science
References
Cafasso, J. (2015). Why does my New Born Grunt? Retrieved on March 19th 2016 from
http://www.healthline.com/health/parenting/newborn-grunting
Finster, M., & Wood, M. (2015). The Apgar score has survived the test of time.
Anesthesiology 102 (4): 855–857.
Speak up (2016). The Universal Protocol for Preventing Wrong Site, Wrong Procedure and
Wrong Person and Wrong. Guidance for Health Care Professionals. The Joint
Commission.
